Effects of a healthy diet enriched or not with pecan nuts or extra-virgin olive oil on the lipid profile of patients with stable coronary artery disease: a randomised clinical trial.

BACKGROUND: The present study aimed to assess the effect of a healthy diet, enriched or not with pecan nuts or extra-virgin olive oil, on the lipid profile of patients with stable coronary artery disease (CAD). METHODS: This was a randomised clinical trial conducted for 12 weeks with patients aged between 40 and 80 years with stable CAD for more than 60 days. Individuals were randomised into groups [control group (CG) with 67 patients, pecan nut group (PNG) with 68 patients and olive oil group (OOG) with 69 patients]. The CG was prescribed a healthy diet according to the nutritional guidelines; the PNG was prescribed the same healthy diet plus 30 g day-1 of pecan nuts; and the OOG was prescribed a healthy diet plus 30 mL day-1 of extra-virgin olive oil. RESULTS: In total, 204 subjects were submitted to an intention-to-treat analysis. After adjustment for baseline values and type of statin used, there was no difference regarding low-density lipoprotein (LDL)-cholesterol (primary outcome), high-density lipoprotein (HDL)-cholesterol, LDL-cholesterol/HDL-cholesterol ratio and HDL-cholesterol/triglycerides ratio according to groups. However, the PNG exhibited a significant reduction in non-HDL-cholesterol levels [PNG: 114.9 (31) mg dL-1 ; CG: 127 (33.6) mg dL-1 ; OOG: 126.6 (37.4) mg dL-1 ; P = 0.033] and in the total cholesterol/HDL-cholesterol ratio [PNG: 3.7 (0.7); CG: 4.0 (0.8); OOG: 4.0 (0.8); P = 0.044] compared to the CG and OOG. CONCLUSIONS: Supplementing a healthy diet with 30 g day-1 of pecan nuts for 12 weeks did not improve LDL-cholesterol levels but may improve other lipid profile markers in patients with stable CAD.

Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index.

BACKGROUND: Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS: The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS: Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS: MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.

Nutrition screening in public hospital emergency rooms: Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002 can be applied.

OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.